Overcoming the barriers of osteoporosis treatment--a better route and a longer use.

The incidence of osteoporosis, defined as decreased bone mass and altered microarchitecture of the bone, has inevitably increased in postmenopausal women. The subsequent morbidity arising from osteoporosis, which includes vertebral and/ or hip fractures, can lead to debilitating health outcomes and a considerable economic burden on the health care system. Therefore, recent attention, which includes the author's study in this issue, has focused on the use of various kinds of drugs to manage osteoporosis in postmenopausal women. There are several agents (i.e., antiosteoporosis drugs) available for treating osteoporosis such as conventional estrogen-based hormone therapy, bisphosphonates (e.g., alendronate, ibandronate, risedronate, zoledronic acid), calcite, selective estrogen receptor modulators (e.g., raloxifene), parathyroid hormone (e.g., teriparatide), and RANK ligand inhibitors (e.g., denosumab). All of these medications have demonstrated their efficacy in the prevention of osteoporosis and osteoporosis-related fracturesdespecially vertebral fracturesdin postmenopausal women. However, osteoporosis remains a challenging disease to treat because of several barriers such as occasional irregular patient adherence to therapies. The decision to use an antiosteoporosis drug should be tailored to the patient's specific clinical scenario. The extent of compliance with osteoporosis pharmacological treatment, as measured by the medication possession ratio, is reportedly poor in clinical practice. Poor compliance is defined as a medication possession ratio less than the threshold of 0.80. Noncompliance can arise from several different causes, which include an overlooked risk of osteoporosis and osteoporosis-related morbidity and mortality, an inconvenient use of an antiosteoporosis agent (e.g., teriparatide), adverse effects of an agent such as gastrointestinal upset after administration of the oral form of bisphosphonate, exacerbating climacteric symptoms after raloxifene use, and anxiety concerning unwanted adverse effects such as increased breast cancer risk with conventional estrogen-based hormone therapy. Bisphosphonates are first-line agents in the treatment of osteoporosis and are efficacious in substantially reducing the fracture risk between 25% and 70%, on average, depending on the fracture site. They also are the same agent as oral minodronate that is referenced in the authors' study published in the current issue. However, patient compliance with oral